OBJECTIVES: To describe long-term symptom persistence and healthcare utilisation related to SARS-CoV-2 infection over a five-year follow-up period in a multicentre cohort of patients with confirmed COVID-19 in Spain.
METHODS: We conducted a multicentre cohort study including individuals aged ≥ 16 years with RT-PCR-confirmed SARS-CoV-2 infection in Cantabria, Spain, between March 2020 and March 2022. Early follow-up (1-2 years post-infection) involved in-person interviews using a standardised questionnaire. Late follow-up (5 years post-infection) was based on electronic health record review. Outcomes included persistent symptoms, long COVID diagnoses, and healthcare utilisation related to post-COVID symptoms.
RESULTS: The cohort included 266 participants (198 hospitalised and 68 non-hospitalised). Among 200 participants with available early follow-up, 112/200 (56.0%) reported at least one persistent symptom during the medium-term post-infection period (1-2 years after SARS-CoV-2 infection). Persistent symptoms occurred in 76/132 (57.6%) hospitalised participants and in 36/68 (53.0%) non-hospitalised participants. Fatigue was the most frequent symptom in both groups. Only 9 participants (3.4%) had a formal diagnosis of long COVID recorded in their medical records. Female sex, chest pain during acute infection, and smoking were associated with symptom persistence. At five-year follow-up, 38 participants (14.3% of the total cohort; 19.0% of those with early follow-up) sought healthcare for symptoms compatible with post-COVID conditions. However, these encounters were not formally attributed to prior SARS-CoV-2 infection in the medical records.
CONCLUSIONS: Persistent symptoms were common during the medium-term post-infection period, while formal long COVID diagnoses and healthcare encounters explicitly attributed to COVID-19 were relatively uncommon in routine clinical records at five years. These findings highlight the challenges of recognising and attributing long-term post-COVID manifestations in clinical practice and suggest that the burden of long-term post-COVID symptoms may be under-recognised in healthcare systems.
